Healthcare Provider Details

I. General information

NPI: 1205800919
Provider Name (Legal Business Name): DEBORAH DIANE MYRES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SW NYE ST
NEWPORT OR
97365-3821
US

IV. Provider business mailing address

238 CAMP 12 LOOP
TOLEDO OR
97391-9620
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-6611
  • Fax: 541-574-6252
Mailing address:
  • Phone: 541-444-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number82010573
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: